Nils Bergman, M.D., is a Public Health Physician, an Honorary Senior Lecturer at the University of Cape Town, South Africa, and a research affiliate of the South African Medical Research Council. Dr. Bergman was born in Sweden and raised in Zimbabwe, where he later worked as a mission doctor. He received his medical degree from the University of Cape Town, and a Masters in Public Health from the University of the Western Cape. During his years in Zimbabwe he completed a doctoral dissertation (M.D., equivalent to a Ph.D.) on scorpion stings. He has worked in rural South Africa, Zimbabwe and Sweden, and was most recently Senior Medical Superintendent of Mowbray Maternity Hospital in Cape Town, where he oversaw 18000 births a year. On October 13 he held a pre-conference workshop as part of the BirthWorks International Conference “Finding the TRUTHS About Birth,” October 14-16, 2016. Cathy Daub, the founder of BirthWorks, attended the conference. She has generously agreed to summarize his talk here.
Babies and Mothers Should NOT Be Separated After Birth, Here’s Why
By Cathy Daub
Listening to Nils Bergman speak during the BirthWorks full-day preconference workshop, the audience of nurse midwives, doulas, medical doctors, and other birth professionals and I found ourselves taken quickly and deeply into two of the ancient truths Dr. Bergman wanted us to understand. Dr. Bergman had the audience repeat them again and again:
1. Zero separation.
2. The mother should never be left alone.
These two phrases are now etched into our brains, not to be forgotten. As we ponder their meaning, we are taken to deeper levels of understanding how crucial zero separation and never leaving the mother alone are for the health of the mother and baby at birth and even into adulthood.
Yes, there are long-term consequences to what happens to a baby in this primal period from conception to the end of the first year of life.
Dr. Bergman began his talk by stating that much of science is based on assumptions, and that these assumptions are sometimes incorrect.
We assume, for example, that hospital incubators are safe for preterm infants.
But, according to Dr. Bergman, extensive evidence shows that incubators are perceived as life threatening by the preterm infants who are placed in them, and being in an incubator has a negative effect on an infant’s brain. Dr. Bergman said that the environment influences everything; the optimal environment for the baby is on his mother’s chest, skin-to-skin, not in an incubator far from her comforting touch, voice, and smell. The environment controls the epigenetic switch in the genes and determining how proteins are made during development, including those that make neurons.
Dr. Bergman said we must understand what is going on in the infant brain. He said there are more synapses in the brain of a newborn baby than there are stars in the galaxy. Every baby is born with the full potential of the universe!
In fact, half of what is interesting in the brain, happens before birth. At 28 weeks gestation, the last neurons are born. After that time, the brain grows by developing circuits between the neurons; memory is stored – not in the neurons but in the circuits. By the time a baby is born, the brain is fully functional.
Repeated hard firing is necessary to connect one neuron to another. Baby kittens born without Rapid Eye Movement (REM) sleep are born blind because REM sleep fires the retina. It is repeated firing that makes circuits that make sight possible in kittens. Sleep cycling in humans occurs only in skin-to-skin contact, and this is when the brain is being wired. We need sleep cycling to have brain maturity.
Another phrase Dr. Bergman repeated is “The mother should never be left alone,” meaning that while she has her baby skin-to-skin, she herself should always have company of another safe adult, the baby’s father, or a safe and loving family member.
It is the maternal sensations that help regulate the baby’s brain. The mother precisely controls every element of her infant’s physiology, including its heart rate, release of hormones, appetite, and intensity of activity. Dr. Bergman (drawing on the work of Myron Arms Hofer) said this creates an invisible hothouse in which the infant’s development can unfold. The mother must feel safe, protected, and relaxed in order to keep the baby feeling safe, protected, and relaxed.
Bergman asked us, “When does an infant become conscious?”
My mother was born in 1922. In her generation, there was a belief that babies didn’t know very much at birth, that they weren’t very conscious. But Dr. Bergman explained that at the moment of birth, nothing is as conscious as a newborn baby and the first hours after birth are a critical period for activating the baby’s neuronal connections in order for the brain to grow.
Separation of the baby from his mother is life threatening because it causes dysregulation in the body physiology, and social withdrawal in the brain, which, when prolonged, becomes permanent, as evidenced by decreased play and slouched posture. This is followed by physiological disturbance in the regularity of heart rate, body temperature, sleep patterns, cortisol secretions and a weakening of the immune system. Separation causes stress and leads to the production of the stress hormone, cortisol, which impacts epigenetics or gene expression and in turn influences how the DNA makes its protein.
Dr. Bergman then approached the question of “Should neonates sleep alone?”
His answer was an emphatic “No! Zero separation is the science.”
Research shows the presence of a doula increases oxytocin and decreases fetal distress. The mere presence of oxytocin proves the mother feels safe. In fact, it is the sense of safety that makes the oxytocin. Oxytocin and dopamine (pleasure hormone) circuits need to connect together. Dr. Bergman showed a slide indicating that a midwife helps to decrease cortisol, the doula helps to increase oxytocin, and the father helps to increase dopamine in the woman in labor.
Dr. Bergman stressed that “The mother must never be alone,” and also that the first 1,000 minutes are crucial for the physical and emotional health of the mother and baby.
We’ve all seen or heard about the back to sleep campaigns from the CDC and the AAP. But Dr. Bergman’s research shows that putting babies on their back to sleep (“supine sleep”) may not be optimal. His research showed different measures of sympathetic stress in babies sleeping on their backs. He said that babies in separation do not sleep. Separation from the mother disturbs infant sleep. For the brain to mature there needs to be sleep cycling. Supine sleep comes with no sleep cycling and in fact profoundly disrupts sleep cycling. Bergman claimed that a baby lying on his back may look like he is sleeping but he really isn’t because how can anyone sleep when in a stressed state!
I asked Dr. Bergman after the conference if that applies to adolescents and adults as well and he responded that there is some research to support that it does.
He explained that with supine sleep, you get parasympathetic shut down and the parallel increase in sympathetic tone, which does not happen normally, keeps the baby awake and increases REM sleep, which does not allow for sleep cycling and resulting brain maturity. Separation disturbs sleep and you get a cortisol effect.
Both Nils Bergman and obstetrician and childbirth expert Michel Odent, M.D. (who also spoke at the conference) said that we have to learn to think long-term. The risk of suppression or disruption of needed neural processes is very significant and potentially lasts a life time, as shown by the work of Stanley Graven, M.D., a professor at the University of San Francisco. If we interfere with infant and toddler sleep, we can interfere with the orexin circuits by methylation–the very mechanism that makes our neurodevelopment possible. Sleep is that important.
Dr. Bergman then described autism as a condition of the “connectome” where networks in the brain that are supposed to connect, fail to do so. When a baby lies on her back, in the stressed state, the brain can’t establish a sleep/wake cycle and therefore the brain can’t mature in the way it was intended. He said that autism is hard to develop because the body has a first line of defense against adverse gene expression, but when that line of defense is gone, the gene can be expressed. Therefore, if there is a genetic code for autism, it may not be expressed unless the first line of defense is gone. That first line of defense just might be lost when a baby is put to sleep on his/her back, supine.
Dr. Bergman went on to say that with autism, the common denominator is a dysfunctional Fusiform Gyrus and the prefrontoorbital area of the brain. There is abnormal functional connectivity of the default mode sub-networks in autism with a disruption of the orbital frontal oxytocin and dopamine circuits. Supine sleep has increased the incidence of specific particular autistic criteria in the population.
Dr. Bergman has a way of saying something so we won’t forget it. He mentioned that no mammals lie their babies on their backs to sleep! As humans are mammals, it is not natural for us to do that either. This information comes at a time when the SIDS Task Force is recommending that mothers lie their babies on their backs to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Bergman showed a graph of five countries–Denmark, United Kingdom, Australia, Israel, and the USA–all countries which began anti SIDS campaigns by telling mothers to lie their babies on their backs.
The results? A four-fold increase in the rate of autism with a decrease in the rate of SIDS. Dr. Bergman explained that SIDS is a defect in the gasp reflex which is actually quite rare.
Supine sleep does reduce SIDS but supine sleep is a stressor that may carry a side effect–autism in those babies who have susceptible genes. Remember that the incidence of SIDS is very rare, (was 1, now 0.5/1000 babies). Acknowledging that autism is not a new phenomenon, Dr. Bergman suggested that perhaps the very thing, SIDS, that we are trying to decrease, has the side effect of increasing autism.
He said: “The result is that treating the whole population by encouraging supine sleep, may result in a rare side effect (autism) becoming more common than the disease (SIDS) being treated.”
Dr. Bergman accepted that before the 1990s autism was a known brain disorder, but he said you need a lot of gene problems to get autism and then you need to activate all of these genes. In fact, he said it is difficult to get autism. Epigenetics or environmental influences can result in network disruption that activates genes with autism. He said if you don’t have these genes, you can’t get autism, even if you are treated badly.
But supine sleep is a stressor!
It is an epigenetic phenomenon of sleep disturbance–a late insult.
Skin-to-skin contact, breastfeeding, vaginal birth, co-sleeping, and bonding are all compensatory mechanisms that can buffer autistic gene expression.
Dr. Bergman described resilience as the capacity to maintain healthy emotional functioning in the aftermath of stressful experiences.
When infants are in stressed states, they develop an allostatic overload that can result in disease.
And yet there is resilience because first the infant must develop susceptibility.
One infant may have more resilience than another. However when looking at an entire population, Dr. Bergman said we will see poorer health in the presence of allostatic load allostasis.
Dr. Bergman said that the health of a population in thirty years’ time is directly related to the quality of their perinatal care.
Zero separation is a public health message.
The fetus asks “Am I safe?”
If the answer is “Yes” then the body produces oxytocin.
If the fetus feels unsafe, he produces vasopressin, a stress hormone, and then cortisol.
When asked, “How long to keep skin-to-skin contact with the mother and her baby?” Bergman replied, “Until the baby tells you ‘I’ve had enough.’”
Dr. Bergman emphasized again and again that maternal/infant separation has NO scientific foundation.
The newborn’s environment IS the mother.
The baby is 100% dependent on his mother.
Even a one-year-old is 99% dependent on his mother. The baby depends on his mother for sensory social stimulation.
Preterm separation totally deprives the baby of every single maternal input that feeds the baby’s physical psychological, and neurological development. The absence of buffering protection of adult support equals toxic stress. Kangaroo care (KC)(mother baby skin-to-skin contact) and oxytocin are direct opposites to mother- baby separation and the production of the stress hormones including cortisol. Maternal separation is toxic stress.
Bergman emphasized that zero separation is our biology. The scientific basis of Kangaroo Mother Care (when a human mom carries a baby skin-to-skin in a front pouch or sling) is neuroscience based on 50 years of mammalian/private research and ten years of modern neuroscientific research. Skin-to-skin contact must start at birth and must be a continuum without separation. Skin-to-skin contact:
• Assures safe neuroception
• Regulates basic physiology
• Provides positive sensations
• Organizes states (sleep and feed)
• Optimizes bonding and attachment
To make his point Dr. Bergman quoted sleep expert James J McKenna, Ph.D., “There is no such thing as infant sleep. There is no such thing as breastfeeding. There is only ‘breast sleeping.’”
We must work together, talking and educating parents and involving parents in the safe care for their babies. The mother should never be left alone; zero separation is the science.
The human body is wiser than we think. For example, a cesarean baby suckles long before a vaginal birth baby, even suckling with mom on the surgical table while she is being stitched up. This suckling helps to control the bleeding. There is an innate wisdom that we can trust.
Bergman ended his workshop with three targets upon which perinatal health care could focus to protect the otherwise healthy newborn:
• Safe early skin-to-skin contact in the delivery room
• Safe breastfeeding established in first days of life
• Secure positioning of infants during sleep.
Cathy Daub is a physical therapist who has worked with special needs children over the last 30 years. She is founder, designer, and president of BirthWorks International, a nonprofit organization with certification programs for childbirth educators, birth doulas, postpartum doulas and their new ACED (Accelerated Childbirth Education Doula) program. The mother of two, Cathy is also the author of Birthing in the Spirit, which offers a human values approach to childbirth.